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Advanced Heart Failure Epidemiology and Outcomes: A Population-Based Study
Shannon M Dunlay1, Véronique L Roger2, Jill M Killian3
1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA; Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA.
JACC. Heart Failure
|August 15, 2021
Summary
Advanced heart failure (HF) affects 13.7% of HF patients, with poor survival regardless of ejection fraction (EF). Understanding advanced HF prevalence and outcomes is crucial for patient care.
Area of Science:
- Cardiology
- Epidemiology
- Heart Failure Research
Background:
- Advanced heart failure (HF) is characterized by debilitating symptoms refractory to therapy.
- Limited data exist on the epidemiology and outcomes of patients with advanced HF.
Purpose of the Study:
- To evaluate the prevalence, characteristics, and outcomes of patients with advanced heart failure (HF).
- To assess hospitalization and mortality rates in advanced HF based on ejection fraction (EF) type.
Main Methods:
- Population-based cohort study of adults with and without HF from 2007 to 2017.
- Applied 2018 European Society of Cardiology advanced HF diagnostic criteria.
- Examined hospitalization and mortality using Andersen-Gill and Cox models, stratified by EF (HFrEF, HFmrEF, HFpEF).
Main Results:
- 13.7% of 6,836 HF patients met advanced HF criteria.
- Prevalence increased with age and was higher in men.
- Median survival post-diagnosis was 12.2 months; hospitalization rate was 2.91 per person-year.
- No significant differences in all-cause mortality or hospitalization risk by EF.
- Advanced HFpEF patients had lower cardiovascular mortality risk than advanced HFrEF.
Conclusions:
- Over half of advanced HF patients have mid-range or preserved EF.
- Survival remains poor across all EF types in advanced HF.
- Findings highlight the need for further research and improved management strategies for advanced HF.
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